Delayed surgery for bladder cancer not harmful

Contrary to several recent reports, delaying bladder cancer surgery for several weeks after diagnosis does not worsen a person’s odds of surviving the disease, Swedish investigators report in The Journal of Urology. The author of a related editorial, however, contends that the sooner the surgery is performed, the better.

Recent research suggesting that delays between diagnosis and surgery in patients with bladder cancer adversely affects survival is “alarming” because it suggests that slow hospital routines influence patient prognosis, Dr. Fredrik Liedberg and colleagues from Lund University Hospital write.

They studied the issue of treatment delay and prognosis in all 141 patients who underwent bladder removal for advanced bladder cancer at their hospital during an 8-year period.

The time from cancer diagnosis to bladder removal was typically about 49 days, according to the team. However, a longer treatment delay - 63 days - was observed for the 71 patients who were initially seen at another hospital before being referred to the researchers’ center.

According to Liedberg and colleagues, “treatment delay did not influence (the risk) of death from bladder cancer. Considering all cases, there was no significant correlation between treatment delay and” progression of the cancer.

In an editorial comment, Dr. Michael Cookson of Vanderbilt University in Nashville notes that this study addresses “an important topic which has received increasing attention. Specifically, does delay in treatment compromise survival?”

While the current study suggests that the answer is no, the “preponderance of evidence” to date suggests that a delay of more than 90 days does have a significantly negative impact on outcomes including…survival, Cookson points out.

Moreover, in the current series, most patients were treated “relatively expeditiously”, so the “true impact of delay may not be detectable in this study,” he contends.

Cookson believes there is a “window of curability that can be exceeded. Therefore, once the decision has been made to perform (bladder removal), it should be performed in a timely fashion,” he concludes.

SOURCE: The Journal of Urology, November 2005.

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